Pedicled Thoracodorsal Artery Perforator and Muscle-Sparing Latissimus Dorsi Flaps in the Axillary Reconstruction After Hidradenitis Suppurativa Excision

Abstract

Background Wide axillary reconstruction after hidradenitis suppurativa (HS) excision still represents a great challenge. Thoracodorsal artery perforator flap is one of the most reliable local reconstructive techniques. Although its anatomy and harvesting technique have been well described, specific reconstructive criteria still lack. The aim of this study was to help surgeons in planning axillary reconstruction on flaps based on the thoracodorsal artery. Methods Twelve patients affected by HS at Hurley stage III underwent wide “en block” excision and immediate reconstruction with 15 local thoracodorsal artery perforator flaps and 2 muscle-sparing latissimus dorsi flaps. A thorough chart review has been performed with preoperative and postoperative photographic documentations. Early and late complications have been analyzed. Results A total of 15 perforator flaps on thoracodorsal artery and 2 muscle-sparing latissimus dorsi flaps have been raised. The early complication rate was 29%, whereas the late complication rate was 35%. Except for one, all patients declared they were satisfied or highly satisfied from both aesthetic and functional points of view. Analyzing specific aspects, we have described several important details to consider for the reconstruction of the axilla. Through a retrospective analysis, we have classified HS axillary patients into 4 categories to better plan surgical reconstruction. Conclusions Axillary reconstruction is still a plastic surgery challenge. Peculiar surgical details should be considered when approaching this area. This new classification may help young surgeons during the reconstructive phase.

The Thin bilateral and bipedicled DIEAP flap for axillary reconstruction in hidradenitis suppurativa

“…Bacteria are removed by radically resecting the affected tissue and carrying the operation on healthy tissue. The TDAP flap is considered the gold standard for axillary reconstruction after hidradenitis suppurativa, since it allows effective re-construction, with like with like skin, a pedicled flap without the need for microsurgery and excellent functional outcomes [4,5].…”

“…Based on our experience and on the current literature [1][2][3][4][5][6][7][8][19][20][21], our algorithm for reconstruction of axillary defects following hydradenitis suppurativa treatment is: ▪ Unilateral cases:…”

“…Axillary reconstruction in these cases is usually performed with pedicled perforator flaps. The use of pedicled skin flaps such as the Thoraco Dorsal Artery Perforator (TDAP) flap [4,5], the lateral thoracic flap or other skin flaps such as the parascapular flap [6][7][8], gives good functional results since supple tissue is brought in adequate quantities in order to preserve shoulder function. It has, however, two drawbacks.…”

“…The first one is that bilateral cases need to be treated in two operations, since the operation is carried out in the lateral decubitus and the patient cannot lie on one flap while the other axilla is being operated [4]. The second one is that wide defects, extending beyond the axilla, require large flaps and, as a consequence, closure under tension causes unsightly scars in the scapular or lateral thoracic regions or even the need to skin graft the donor site [5].…”

Aksiller Hidradenitis Süpürativanın Cerrahi Tedavisinde Torakodorsal Arter Perforatör Flep (TDAP) İle Rekonstrüksiyon Deneyimlerimiz

“…Ancak kas fleplerinde alıcı sahada fonksiyon kaybı ve inset sonrası aksilladabulky olasılığı yüksektir. TDAP flep, renk uyumu, ve başarılı fonksiyonel sonuçları nedeniyle aksiller HS tedavisinde altın standarttır (16). Olumsuz yanları ise daha dikkatli ve titiz bir diseksiyon gerektirmesi, buna bağlı olarakda ameliyat süresinin uzamasıdır.…”